Oppositional Defiant Disorder

All children are oppositional from time to time, particularly when they are tired, hungry, or upset. They may throw tantrums, disobey, and/or argue with parents, teachers, and other adults. Oppositional behavior is often a normal part of development for two to three year olds and early adolescents, and is generally even expected. When this behavior becomes so frequent and consistent that it stands out as abnormal or excessive when compared with other children of the same age and developmental level, or when it begins to affect the child's social, academic and family life, there is reason for concern.

Oppositional defiant disorder is a persistent pattern (lasting for at least six months) of negativistic, hostile, disobedient, and defiant behavior in a child or teen without serious violation of the basic rights of others. This disorder is more common in boys than in girls before puberty, but equal in both sexes after puberty. Between 2 and 16 percent of children display this pattern. Some children with ODD may go on to develop called conduct disorder.

Symptoms of ODD:

Individuals with oppositional defiant disorder argue repeatedly with adults, lose their temper, and feel great anger and resentment. They often ignore adult rules and requests, deliberately annoy other people, and blame others for their own mistakes and problems.
This pattern of uncooperative, defiant, and hostile behavior is persistent and serious enough to interfere with day to day functioning.

Individuals with ODD are often very difficult to be around. The destructiveness and disagreeableness they exhibit are purposeful, and they often get enjoyment out of seeing someone else hurt or angry. They are rarely truly sorry for causing others harm, and generally believe nothing is their fault.

Although children with ODD show symptoms very similar to children with ADHD or conduct disorder, there exists some definite differences. Children with ADHD behave impulsively and without thinking, while children with ODD behave very purposefully and often with a well thought out plan. Children with ODD generally do not display the mean or cruel behavior that is so often present in conduct disorder.

Diagnostic Criteria for ODD:

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults' requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive

Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Treatment of ODD:

Treatment of oppositional defiant disorder usually consists of a combination of individual and family therapy. Parents are taught methods to help deal with and prevent the negative behaviors, such as keeping a consistent daily schedule, limit-setting, discipline, and consistent rules and reward systems. Residential treatment and medication are sometimes necessary as well.

It is very rare for a physician to see a child with only ODD. Almost always the child has some other psychiatric disorder along with ODD, such as ADHD, bipolar or depression, or an anxiety disorder. These disorders will also need treatment if the child is to improve.